Reperfusion times of ST-Segment elevation myocardial infarction in hospitals
Reperfusion times of ST-Segment elevation myocardial infarction in hospitals
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DOI：
10.12669/pjms.306.5696
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发表时间：
2014-11
影响因子：
2.2
通讯作者：
Shujuan Dong;Yingjie Chu;Haibo Zhang;Yuhang Wang;Xianzhi Yang;Lei Yang;Long Chen;Haijia Yu
中科院分区：
文献类型：
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作者：
Shujuan Dong;Yingjie Chu;Haibo Zhang;Yuhang Wang;Xianzhi Yang;Lei Yang;Long Chen;Haijia Yu
目的：了解河南省ST段抬高型心肌梗死（STEMI）患者的再灌注时间，并探讨缩短再灌注时间的策略。方法：分析2008年1月至2012年8月河南省30家医院1556例STEMI患者的再灌注时间，其中省级医院736例，市级医院462例，县级医院358例。记录和分析以下数据：时间段1（从症状出现到第一次医疗接触）、时间段2（从第一次医疗接触到诊断）、时间段3（从诊断到提供同意）、时间段4（从提供同意时间到开始治疗）和时间段5（从治疗开始到通畅）。结果：在接受直接经皮冠状动脉介入治疗的患者中，省级医院和市级医院的入院到球囊时间分别为172±13分钟和251±14分钟。两级医院的延误对比为90分钟，很大程度上是由于获得同意的时间延误造成的。接受溶栓治疗的患者中，省级医院、市级医院和乡村医院的到诊时间分别为86±7分钟、91±7分钟和123±11分钟。各级医院均出现延误时间超过30分钟的情况，主要原因是同意时间延误。与指南要求的时间相比，我国STEMI患者的再灌注时间明显延迟。就中国国情而言，门到气球的时间太笼统了。因此，我们建议将此时间细化为首次医疗接触-诊断时间、同意提供时间、治疗准备时间和治疗球囊开始时间。结论：与指南要求的时间相比，我国STEMI患者的再灌注时间明显更长。就中国国情而言，气球时间之门并不适用。因此建议细化为首次医疗接触-诊断时间，提供同意时间、治疗准备时间和治疗开始-球囊时间。
Objective: To investigate the reperfusion time in patients with ST-segment elevation myocardial infarction (STEMI) in Henan Province, China, and discuss the strategies for shortening that period. Methods: The reperfusion times of 1556 STEMI cases in 30 hospitals in Henan Province were analyzed from January 2008 to August 2012, including 736 cases from provincial hospitals, 462 cases from municipal hospitals and 358 cases from country hospitals. The following data: Time period 1 (from symptom onset to first medical contact), Time period 2 (from first medical contact to diagnosis), Time period 3 (from the diagnosis to providing consent), Time period 4 (from the time of providing consent to the beginning of treatment) and Time period 5 (from the beginning of treatment to the patency) were recorded and analyzed. Results: In patients receiving primary percutaneous coronary intervention, the door-to-balloon time of provincial hospitals and municipal hospitals was 172±13 minutes and 251±14 minutes, respectively. The hospitals at both levels had a delay comparison of 90 minutes largely caused by the delay in the time for obtaining consent. In patients receiving thrombolysis treatment, the door-to-needle times of provincial hospitals, municipal hospitals and country hospitals were 86±7, 91±7 and 123±11 minutes, respectively. The hospitals at all levels had delays lasting more than 30 minutes, which was mainly attributed to the delay in the time for providing consent. Compared with the time required by the guidelines, the reperfusion time of patients with STEMI in China is evidently delayed. In terms of China's national conditions, the door-to-balloon time is too general. Therefore, we suggest refining this time as the first medical contact–diagnosis time, consent provision time, therapy preparation time and the start of therapy balloon time. Conclusion: Compared to the time required by the guidelines, the reperfusion time of patients with STEMI in China was obviously greater. In terms of China's national conditions, the door to balloon time is not applicable. So it is suggested to refine it as the first medical contact-diagnosis time, providing consent time, therapy prepare time and the start of therapy – balloon time.